When Less Is More: Volume Considerations in the Treatment of Enterococcus faecalis Endocarditis

A 6-week regimen of intravenous ampicillin and ceftriaxone is currently the consensus, guideline-recommended, first-line treatment for Enterococcus faecalis endocarditis. This regimen is associated with significant salt and volume administration in a patient population susceptible to the development of hypervolemia and heart failure, which are associated with worse clinical outcomes. As a consequence of Hurricane Helene, the United States experienced significant intravenous fluid shortages in 2024 and 2025, prompting hospitals to switch from infusion delivery to push administration of many medications, without reported deleterious effects. Push administration of ampicillin and ceftriaxone and the evidence-based use of partial oral antibiotic therapy are treatment strategies that may help reduce the incidence of hypervolemia and/or heart failure in patients with E faecalis endocarditis.